Colonoscopy (diagnostic)
Facility: Rawlins County Health Center
Billing Code: 45378 (CPT)
- CPT Billing Code: 45378
- Insurance Median: $1,321
- Cash Discount Price: $1,626
- vs. Medicare Baseline: 1.39x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Understanding this gauge: We use the federal Medicare rate of $950.1 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| UnitedHealthcare | $1,031 - $2,297 | 109% |
| Blue Cross Blue Shield | $1,321 | 139% |
Consumer Guidance & Cost Commentary
For a diagnostic colonoscopy at Rawlins County Health Center in Atwood, Kansas, the cash median price is $1,626, which is notably higher than the facility's negotiated rate of $1,321. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should be aware that commercial insurance rates can sometimes exceed cash prices due to administrative overhead and contract dynamics. In this specific case, the negotiated rate of $1,321 is lower than the cash price, meaning patients with high-deductible plans or those who have met their out-of-pocket maximum might find it more cost-effective to pay the cash price directly, provided they can secure a prompt-pay discount. It is crucial to verify your specific plan's allowed amount with UnitedHealthcare or Blue Cross Blue Shield before scheduling, as these payers have negotiated ranges that may differ from the facility's self-pay rates.
The Medicare benchmark for this procedure is $950.10, which serves as a baseline for evaluating the facility's pricing markup. The facility's cash rate of $1,626 represents a significant markup compared to the Medicare amount, and while the data does not provide a direct comparison to state or county averages, understanding the Medicare rate helps contextualize the total cost. If you are billed after insurance payment, you should request an itemized billing audit to ensure no errors, such as unbundled codes or services not rendered, have inflated your final charge. Additionally, if you encounter a balance bill from an out-of-network provider, the No Surprises Act may protect you from paying the difference for emergency care or non-emergency services at an in-network facility, so you should dispute